Counterstrain

Question 1

Is counterstrain a direct or indirect technique?

Answer 1

indirect (away from barrier)

Question 2

Tenderpoint vs Triggerpoint. Which one does counterstrain treat?

Answer 2

• Tenderpoint: pain at that point that does not radiate (treated by counterstrain)
• Triggerpoint: pain at that point that radiates when pressed

Question 3

Explain the nociceptive model of counterstrain

Answer 3

tissue straining recruits nociceptors in that tissue -> reflexive contraction -> contraction becomes the new neutral position

Question 4

Explain the proprioceptive model of counterstrain

Answer 4

muscle strained w/o recruiting nociceptors -> antagonist muscle shortened (turns down spindle firing rate) -> CNS turns up antagonist gamma system - antagonist contraction becomes new neutral

Question 5

Which muscle is affected in the nociceptor model and proprioceptor model of counterstrain?

Answer 5

• nociceptor = agonist

- proprioceptor = antagonist

Question 6

What are the 4 phases of counterstrain?

Answer 6

• relaxation
• resent of spindle fibers and nociceptors
• washout
• slow return to neutral

Question 7

When does peak washout occur?

Answer 7

at approximately 1 minute

Question 8

What are the 7 steps of counterstrain?

Answer 8

• find most significant tenderpoint
• establish tenderness scale
• monitor tender point throughout tx
• place pt in optimal comfort position
• maintain for 90 seconds
• slowly return to neutral
• recheck tender point

Question 9

How long should you maintain position for ribs in counterstrain?

Answer 9

120 seconds

Question 10

What are the general tx positions for midline positions in counterstrain?

Answer 10

primarily flexion or extension

Question 11

What are the general tx positions for positions distant from midline in counterstrain?

Answer 11

primarily sidebending/rotational

Question 12

What do upper case and lower case letters refer to in counterstrain naming?

Answer 12

• upper case indicates more motion

- lower case indicates less motion

Question 13

Example: Explain the tx position for fSaRA

Answer 13

small amount of flexion and sidebending away and large amount of rotation away

Question 14

Example: Explain tx position for FSt

Answer 14

large amount of flexion and small amount of sidebending toward

Question 15

What is therapeutic pulse?

Answer 15

intensity approximates radial pulse

Question 16

position of comfort vs position of optimal comfort

Answer 16

• position of comfort: at least 70% of tenderness alleviated

- position of optimal comfort: 100% of tenderness alleviated

Question 17

Absolute contraindications of counterstrain

Answer 17

• trauma or severe illness w/ strict positional restrictions
• instability of tx area
• vascular/neurological syndromes that might compromise
• severe degenerative spondylosis where tx would take place

Question 18

Relative contraindications of counterstrain

Answer 18

• pt can’t voluntarily relax
• pt can’t discern level of pain
• pt who can’t understand instructions
• pts w/ underlying conditions in whom positioning exacerbates underlying condition

Question 19

Benefits of counterstrain

Answer 19

• passive, indirect
• can be used in pts w/ severe osteoporosis, metastatic bone disease and acute injuries
• only absolute requirement is that pt must be willing and able to relax muscles